This proposal is a competitive renewal of "Hospital Performance and Beta-Blocker Use After AMI" (R01 HS10407), a currently-funded study evaluating hospital strategies to increase beta-blocker prescription at discharge among patients hospitalized with an acute myocardial infarction. In this competitive renewal, we seek to examine variations in hospitals' improvements in time to acute reperfusion therapy (fibdnolytic therapy or percutaneous coronary intervention (PCI)) and to evaluate the effectiveness of different quality improvement strategies in reducing time to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). [unreadable] [unreadable] Although reducing time to reperfusion therapy is a national health care priority, there are no national data concerning hospitals' quality improvement strategies directed at improving this aspect of AMI care or information concerning their effectiveness. Accordingly, we seek to 1) determine the extent of hospital-level variation in changes in the time to reperfusion therapy for patients with STEMI, 2) catalogue and classify hospital quality improvement strategies directed at improving time to reperfusion therapy, and 3) identify hospital quality improvement strategies that are associated with improvements in time to reperfusion therapy. [unreadable] [unreadable] To accomplish our aims, we will combine medical record data from the National Registry of Myocardial Infarction (NRMI) database with originally collected survey data concerning the presence, type and duration of hospital-based quality improvement strategies directed at time to reperfusion therapy. Our approach will allow us to investigate variation in time to reperfusion therapy among hospitals, develop a taxonomy of efforts to reduce time to reperfusion therapy, and empirically identify successful strategies for improving hospital performance. Data generated from these studies will guide efforts by clinicians, administrators, researchers, and policy makers to decrease time to reperfusion therapy for patients with STEMI. [unreadable] [unreadable] [unreadable]